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ONCOLOGY AND PALLIATIVE CARE > OESOPHAGEAL CANCER > Flashcards

OESOPHAGEAL CANCER Flashcards

1
Q

What are the two main types of oesophageal cancer?

A

Adenocarcinoma

Squamous cell carcinoma

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2
Q

Where are most cancers of the oesophagus found?

A

Lower 2/3rds with 50% occurring in the lowest third

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3
Q

What percentage of diagnosed cancers do oesophageal carcinomas represent?

A

5%

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4
Q

What is the sequence of pathology in the development of oesophageal adenocarcinoma?

A

GORD
Barrett’s oesophagus
Invasive adenocarcinoma

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5
Q

What are the oncogenes involved in the development of adenocarcinoma of the oesophagus? Which chromosome are these mutations found on?

A

p53
LOH

Both on chromosome 17

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6
Q

What percentage of patient’s with Barrett’s oesophagus go on to develop adenocarcinoma of the oesophagus?

A

About 10%

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7
Q

Where are carcinomas of the oesophagus most likely to spread to?

A 
Local spread:
Length of oesophagus
Pleura
Trachea
Bronchi
Lung
Aorta

Distant metastases via haematogenous or lymphatic spread:
Liver
Lung

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8
Q

Are most oesophageal cancers squamous in nature or adenocarcinomas?

A

90% are squamous cell carcinomas

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9
Q

Where is the world is oesophageal cancer most commonly seen?

A

China

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10
Q

Is oesophageal cancer more common in men or women?

A

Men

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11
Q

What are the risk factors for developing oesophageal cancer?

A

Smoking
Alcohol
GORD

Rarer:
Achalasia (muscles of the lower part of the oesophagus fail to relax)
Plummer-Vinson syndrome (dysphagia, iron deficiency anemia, and oesophageal webs)
Tylosis (thickening of the skin in the palms of the hands and the soles of the feet)

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12
Q

How might someone with suspected carcinoma of the oesophagus present?

A 
50-80 years old
Dysphagia
Weight loss
Fatigue - anaemia
Vomiting
Haematemesis
Haemoptysis
Pain on swallowing (odynophagia)
Hoarse voice

May present with cough and dyspnoea - due to aspiration

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13
Q

What investigations would you order in someone with suspected oesophageal cancer?

A

FBC
LFTs
U&Es
Endoscopy
Barium swallow - for those who cannot tolerate endoscopy
Endoscopic ultrasound and spiral CT - for staging of disease
PET scan or PET/CT

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14
Q

Why would you do LFTs in someone with suspected oesophageal cancer?

A

Thinking about metastatic spread

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15
Q

Why would you do U&Es in someone with suspected oseophageal cancer?

A

Dehydration due to dysphagia

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16
Q

What three ways might a cancer of the oesophagus be described from endoscopy?

A

Protruding - 60%
Excavating - 25%
Flat - 15%

17
Q

What is the staging process used for oesophageal cancers?

A

TNM

18
Q

What does T1 mean with regard to oesophageal cancer staging using the TNM system?

A

Tumour invades lamina propria or submucosa

19
Q

What does T2 mean with regard to oesophageal cancer staging using the TNM system?

A

Tumour invades muscularis propria

20
Q

What does T3 mean with regard to oesophageal cancer staging using the TNM system?

A

Tumour invades adventitia

21
Q

What does T4 mean with regard to oesophageal cancer staging using the TNM system?

A

Tumour invades adjacent structures

22
Q

What does N0 mean with regard to oesophageal cancer staging using the TNM system?

A

No lymph node involvement

23
Q

What does N1 mean with regard to oesophageal cancer staging using the TNM system?

A

Confined to local nodes

24
Q

What does N2 mean with regard to oesophageal cancer staging using the TNM system?

A

More distant node involvement but still specified for that tumour type. Otherwise classified as M for metastatic.

25
Q

What is the prognosis for someone diagnosed with oesophageal cancer?

A

Exceptionally poor - 2-5% survival rate at 5 years

26
Q

What are the treatment options for someone diagnosed with oesophageal cancer?

A

MDT
Surgery - only possible cure
Radiotherapy - reduces size of tumour, relieves dysphagia
Laser therapy - relieves dysphagia
Endoscopic placement of expanding metal stent
Brachytherapy - radioactive implants

27
Q

What is the operative mortality rate for surgical removal of oesophageal malignant tumour?

A

5-10%

ONCOLOGY AND PALLIATIVE CARE (14 decks)

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